Got fired for changing fluid rate
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I was on orientation on days and then got moved to nights which is what I was hired to do. It was my first night on orientation with a preceptor and I was not feeling the best, was very tired got an... Read More

May 9, '13

i agree here. There is usually a protocol. Especially when most MDs do not call back for a while. I worked the floor for a while and have many pt's BP drop and we just opened the fluids up and let them go. You got the order for the bolus so it was the right thing to do. its the same as saying my pt's 02 sat was low so i waited to give him/her 02 because i didnt have a MD order

May 9, '13

So she was septic or heading that direction? There is usually a sepesis protocol in every hospital What she did had to be with in her hospitals protocols.

May 9, '13

Not all telemetry floors are the same. There's a (big) difference between a true PCU and medical telemetry. Some hospitals have both.

May 9, '13

Many facilities would issue a verbal or written warning for something like this. Perhaps they were looking for a reason to let you go. These days it doesn't take much.

I haven't read through all the postings, but I'm a little confused why you didn't call the Dr? Where I work, we have been known to adjust fluid rates on occasion without an order....but I work in a rural location, and we know what our parameters are.

May 9, '13

If I had personally been told in report that my new patient has a BP in the toilet, I would have been reluctant to accept the patient....and would have had my clinical manager get involved immediately. Now upon receipt of the patient, (if it got that far) I would have been on the phone with my clinical manager as well as the hospitalist to clarify orders, communicate vitals, etc. Did the patient's blood pressure improve after the bolus? Wish we had more information to the story...

At the end of the day, you accepted report from the ER...you accepted the patient upon their arrival...and should have consulted your clinical supervisor and the hospitalist sooner then you did.....but we are all human and all make mistakes...the important part is learning from them and not repeating them

I beg to differ. Post history can be very useful. How we respond to someone with 20+ years of experience vs. a brand new grad will be different. Or if we look at their history, notice that there are 15 posts in the last month about mistakes that he/she made, well, it certainly affects the whole 'Should I have been fired?' response.

Do I think that OP should have been fired for this drip rate issue? No. Reprimanded, given in-service and stern reminders of scope of practice, definitely. BUT...given past issues about being rude to patients, unsafe practice, etc. That perhaps explains being fired a bit better.

And you know what else I just realized? Since posters started commenting that things don't make sense with post history and all, we have not heard from OP. Jus' sayin'.

Touche. Something's up. I just like to give people like that a chance, even if they mess up. There's a lesson and mistake everyone learns from. But of course, there's a limit to that.

May 9, '13

I just find it odd that in May of '12 the OP stated they were a new nurse that has worked one year in LTAC and one month later they posted they were an ICU nurse of 2 years in June of '12. I dunno...?

I'm an ED nurse and bolus is always wide open. If its on a pump it's at 999 mL/hr if its on gravity it's unclamped.

At my hospital, if a physician writes a liter of fluid to be a 'bolus', policy is that it is infused of 1 hour (regardless of unit/floor/etc.). If the physician believes the pt cannot handle a liter in an hour, they should order a specific rate rather than a bolus. Either way, this does not mean the nurse should not monitor the pt for signs of overload.

May 10, '13

Your preceptor wasn't concerned? And, only checking every 30 mins? Should have been checking pressures more frequently than that with pressures like that. You did check the cuff for appropriate fit, etc? I'm mostly concerned that your preceptor wasn't concerned. I'm assuming this is ICU, right? I hope? Definitely need to call the physician with a pressure that low for further orders, line placed, pressors, etc (or transfer to ICU if you're not ICU, call rapid response etc). I'm so sorry this happened to you; you seem like a concerned nurse, but too afraid to go above your preceptor and take action. If you know something is wrong, you have to proceed even if that means it makes you unpopular. I'm also sorry that you had a very uninvolved preceptor (or at least it sounds that way). But, you still have your own nursing judgment, and you have to use that (even when new in a facility).

At my hospital, if a physician writes a liter of fluid to be a 'bolus', policy is that it is infused of 1 hour (regardless of unit/floor/etc.). If the physician believes the pt cannot handle a liter in an hour, they should order a specific rate rather than a bolus. Either way, this does not mean the nurse should not monitor the pt for signs of overload.

Little confused as to what you're getting at. The pt in this scenario had a bolus ordered in the ED then 100 mL/hr on the floor, so the doc was specific. And since this pt was hypotensive she was not at risk of fluid overload...where is that coming from?